Cervical Cancer Awareness Month 2023

 

WHAT IS CERVICAL CANCER?

Cervical cancer is a cancer that starts in the cells of the cervix. The cervix is the lower, narrow end of the uterus (womb). The cervix connects the uterus to the vagina (birth canal). Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue. Over time, if not destroyed or removed, the abnormal cells may become cancer cells and start to grow and spread more deeply into the cervix and to surrounding areas.

You can reduce your risk of developing cervical cancer by having screening tests and receiving a vaccine that protects against HPV infection.

CAUSES OF CERVICAL CANCER

 

Cervical cancer begins when healthy cells in the cervix develop changes (mutations) in their DNA. A cell’s DNA contains the instructions that tell a cell what to do. Healthy cells grow and multiply at a set rate, eventually dying at a set time. The mutations tell the cells to grow and multiply out of control, and they don’t die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from a tumor to spread (metastasize) elsewhere in the body.

It isn’t clear what causes cervical cancer, but human papillomavirus (HPV) certainly plays a role. HPV is very common, and most people with the virus never develop cancer. This means other factors — such as your environment or your lifestyle choices — also determine whether you’ll develop cervical cancer.

TYPES OF CERVICAL CANCER

The type of cervical cancer that you have help determine your prognosis and treatment. The main types of cervical cancer are:

• Squamous cell carcinoma: This type of cervical cancer begins in the thin, flat cells (squamous cells) lining the outer part of the cervix, which projects into the vagina. Most cervical cancers (up to 90%) are squamous cell carcinomas.
• Adenocarcinoma: This type of cervical cancer begins in the column-shaped glandular cells that line the cervical canal.

Sometimes, both types of cells are involved in cervical cancer. This is called mixed carcinoma or adenosquamous carcinoma.

SYMPTOMS

Early on, cervical cancer may not cause signs and symptoms. Advanced cervical cancer may cause bleeding or discharge from the vagina that is not normal for you, such as bleeding after sex. If you have any of these signs, see your doctor. They may be caused by something other than cancer, but the only way to know is to see your doctor.

Signs and symptoms of more advanced cervical cancer include:

• Vaginal bleeding after intercourse, between periods, or after menopause
• Watery, bloody vaginal discharge that may be heavy and have a foul odor
• Pelvic pain or pain during intercourse

Symptoms of advanced cervical cancer (cancer has spread beyond the cervix to other parts of the body) may include the symptoms of early-stage cervical cancer and

• Difficult or painful bowel movements or bleeding from the rectum when having a bowel movement
• Difficult or painful urination or blood in the urine
• Dull backache
• Swelling of the legs
• Pain in the abdomen
• Feeling tired

WHAT ARE THE RISK FACTORS FOR CERVICAL CANCER?

Almost all cervical cancers are caused by human papillomavirus (HPV), a common virus that can be passed from one person to another during sex. There are many types of HPV. Some HPV types can cause changes in a woman’s cervix that can lead to cervical cancer over time, while other types can cause genital or skin warts.

HPV is so common that most people get it at some time in their lives. HPV usually causes no symptoms so you can’t tell that you have it. For most women, HPV will go away on its own; however, if it does not, there is a chance that over time it may cause cervical cancer.

Other things can increase your risk of cervical cancer such as:

• Having chlamydia, gonorrhea, syphilis, HIV (Human Immunodeficiency Virus), or another condition that makes it hard for your body to fight off health problems.
• You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.
• Tobacco smoking.

CERVICAL CANCER STAGES

After someone is diagnosed with cervical cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of cancer describes the extent of cancer in the body. It helps determine how serious the cancer is and how best to treat it. The stage is one of the most important factors in deciding how to treat cancer and determining how successful treatment might be. Cervical cancer stage ranges from stages I (1) through IV (4).

• Stage 1A: The tumor is in the cervix and can only be seen with a microscope. The tumor is not more than 5 mm deep and not more than 7 mm wide.
• Stage 1B: The tumor is in the cervix and can be seen without a microscope or the tumor can only be seen with a microscope but is bigger than a stage 1A tumor.
• Stage 2A: The tumor has grown outside of the cervix and the uterus but hasn’t grown into the walls of the pelvis or to the lower part of the vagina. It also hasn’t grown into tissues next to the cervix and uterus (called the parametria).
• Stage 2B: The tumor has grown outside of the cervix and the uterus into tissues next to the cervix and uterus. The tumor hasn’t grown into the walls of the pelvis or to the lower part of the vagina.
• Stage 3A: The tumor has grown into the lower part of the vagina but not into the walls of the pelvis.
• Stage 3B: The tumor has grown into the walls of the pelvis, blocks a ureter (the tube that carries urine from the kidney to the bladder) causing an enlarged kidney (hydronephrosis), or stops the kidney from working. Or the tumor has grown into the walls of the pelvis, blocks a ureter (the tube that carries urine from the kidney to the bladder) causing an enlarged kidney (hydronephrosis), or stops the kidney from working.
• Stage 4A: The tumor has grown into the bladder, rectum, or outside of the pelvis.
• Stage 4B: Cancer has spread to other parts of the body (called distant metastasis), such as to lymph nodes outside of the pelvis or to the lungs, liver, or bone. This is also called metastatic cervical cancer.

WHAT IS THE PEAK AGE FOR CERVICAL CANCER?

Cervical cancer is most frequently diagnosed in women between the ages of 35 and 44 with the average age at diagnosis being 50. It rarely develops in women younger than 20. Many older women do not realize that the risk of developing cervical cancer is still present as they age. More than 20% of cases of cervical cancer are found in women over 65. However, these cancers rarely occur in women who have been getting regular tests to screen for cervical cancer before they were 65.

DIAGNOSIS AND TREATMENT

Cervical cancer is treated in several ways. It depends on the kind of cervical cancer and how far it has spread. Treatments include surgery, chemotherapy, and radiation therapy.

• Surgery: Doctors remove cancer tissue in an operation.
• Chemotherapy: Using special medicines to shrink or kill the cancer. The drugs can be pills you take medicines given in your veins, or sometimes both.
• Radiation: Using high-energy rays (similar to X-rays) to kill the cancer.

Different treatments may be provided by different doctors on your medical team.

• Gynecologic oncologists are doctors who have been trained to treat cancers in a woman’s reproductive system.
• Surgeons are doctors who perform operations.
• Medical oncologists are doctors who treat cancer with medicine.
• Radiation oncologists are doctors who treat cancer with radiation.

SCREENING OPTIONS

The HPV test and the Pap test are screening tests that can help prevent cervical cancer or find it early.

• The human papillomavirus (HPV) test looks for the virus that can cause cell changes on the cervix.
• The Pap test (or Pap smear) looks for precancers, which are cell changes on the cervix that might become cervical cancer if they are not treated appropriately.

You should start getting Pap tests at age 21. If your Pap test result is normal, your doctor may tell you that you can wait three years until your next Pap test.

If you’re 30 to 65 years old, you have three options. Talk to your doctor about which testing option is right for you.

• An HPV test only. If your result is normal, your doctor may tell you that you can wait five years until your next screening test.
• An HPV test along with the Pap test. If both of your results are normal, your doctor may tell you that you can wait five years until your next screening test.
• A Pap test only. If your result is normal, your doctor may tell you that you can wait three years until your next Pap test.

If you’re older than 65, your doctor may tell you that you don’t need to be screened anymore if you have had normal screening test results for several years and you have not had a cervical precancer in the past, or you have had your cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids.

HPV VACCINE

Gardasil 9 is the only FDA-approved HPV vaccine in use in the United States. It enables your body to fight many different types of HPV, including:

• HPV 16 and 18, which cause close to 70% of cervical cancers
• HPV 31, 33, 45, 52, and 58, which cause 10–20% percent of cervical cancers

Two other vaccines, Gardasil and Cervarix, are available in other parts of the world. They protect against HPV types 16 and 18, which cause the majority of cervical cancer cases.

The CDC recommends that children be vaccinated between 11 and 12 years of age to make sure they’re protected before becoming sexually active. According to the CDC, anyone can be vaccinated by age 26. However, the vaccine isn’t always recommended for people between 27 and 45 unless there are special circumstances. That’s because many people in this age range have already been exposed to the HPV virus

FINAL THOUGHT

During January, let us highlight issues related to cervical cancer, HPV disease, the importance of improving access to HPV vaccination, early screening, treatment, and management of cervical cancer. Although cervical cancer can be diagnosed as early as 20 or beyond the age of 60, it’s most often diagnosed between the ages of 35 and 44. This is why routine cervical cancer screenings which can monitor your cervix for signs of cancer development are important.